Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD00020678 | WA |
NPI | 1023071966 |
---|---|
Provider Name | Mr. Robert Love Huck |
First Address | Olympia, WA 98503-5197 |
Second Address | Olympia, WA 98503-5197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 06/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8479800 | (05) | WA |
A55209 | (02) | WA |